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Effective: December 1, 2006 |
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23.45.20ar1 - Designated Provider Option (Archive) |
Archived: October 1, 2008 |
Some clients may pick one provider whom they pay their spenddown amount each month. This option is referred to as Designated Provider.
Note: Providers cannot refuse to be designated providers.
See Spenddowns – Designated Provider for more information regarding:
l Clients using a community income calculation.
l System information on the designated provider option.
l Using a different provider in emergencies.
l The county as a designated provider.
l Provider notices.
l Provider numbers.
l Designated Provider errors.
l EVS information to providers.
Clients with a Long-Term Care (LTC) spenddown must use this option.
l The LTCF is the designated provider.
Exception: Clients receiving hospice services must use the hospice provider as the designated provider.
l Do not require the client to sign the Agreement to Use Designated Provider (DHS-3161).
l Workers must notify the LTCF when the LTC spenddown amount changes or ends. The system will not send the provider a notice for LTCF residents.
Clients who move between facilities must have coordination of the designated provider payment completed.
l For clients who move on the first of a month, create a new spenddown span of information with the new provider number in MMIS.
l For clients who move mid-month:
n Determine the amount the client owes the facility of discharge.
m Contact the provider the client was discharged from for the daily per diem rate.
m Multiply the per diem by the number of days the client resided in that facility, not counting the day of the move.
m Enter that amount, up to the total LTC spenddown amount, for the facility of discharge.
n Update the current spenddown span in MMIS with the second facility’s provider number, designated provider amount and an end date.
m Deduct the LTC spenddown amount met by the facility of discharge from the full LTC spenddown amount.
m Enter the remaining amount of the LTC spenddown for the new facility.
n Enter a new spenddown span for the following month’s LTC spenddown using the new facility as the designated provider.
Clients with a waiver obligation may choose to use this option.
Exceptions: The following clients with a waiver obligation may not choose the designated provider option when:
q They are receiving services through the Minnesota Senior Health Option (MSHO) program.
q They have more than one waivered services provider and no single provider meets the total waiver obligation amount with the total services that provider provides.
Clients with a waiver obligation who choose the designated provider option must follow these requirements:
l A waivered service provider must be selected as the designated provider.
Note: A client with more than one waivered services provider must choose one provider that will satisfy the waiver obligation as the designated provider. If no single provider can satisfy the obligation with costs of services, the designated provider option cannot be used.
Example:
Henry has a waiver obligation of $320 each month. He has three EW providers. He receives $200 in services from the first provider, $150 from the second and $300 from the third.
Action:
Henry does not have a single waivered services provider who satisfies the waiver obligation. He cannot use the designated provider option.
l The client must be willing to pay the waiver obligation amount to the provider at the time they receive the services.
n Check past payment history and other factors to determine there is a strong likelihood the client will cooperate with paying the designated provider.
n If a provider reports a client has refused or failed payment remove the client from the designated provider option but do not close eligibility.
l Begin the option beginning the month following the month eligibility is approved.
l The designated provider option cannot be added, changed or deleted for a current month or a retroactive month.
l Clients must sign the Agreement to Use Designated Provider (DHS-3161) form.